Paid Leave for Personal and Family Illness: Impacts of State Policy Design on Coverage and Access by Race, Gender, and Education Level.

CONTEXT

Paid leave for serious personal and family illnesses can significantly improve health outcomes. With no federal paid family and medical leave (PFML) policy, states are increasingly adopting their own. Yet eligibility criteria for paid leave and job protection vary markedly across states, as does benefit adequacy, affecting coverage and equity.

METHODS

The authors developed a database of state-level paid leave policies to systematically analyze each state's eligibility criteria for leave and job protection. They applied the policy database's detailed criteria to employment data from the US Current Population Survey Annual Social and Economic Supplement to analyze eligibility by race/ethnicity, gender, and education. They measured benefit adequacy by analyzing whether family income would drop below the federal poverty threshold during a worker's leave.

FINDINGS

Minimum earnings, tenure, and hours rules disproportionately exclude workers with less education and women from paid leave and/or job protection. Minimum firm size disproportionately excludes workers with less education and Latinx workers from job protection. Black and Latinx workers' family income is more likely to fall below poverty during leave.

CONCLUSIONS

State-level PFML has expanded coverage in the absence of a federal policy. Remaining gaps and inequities could be reduced by lowering or eliminating requirements for minimum firm size, tenure, and hours; raising wage replacement rates; and ensuring full job protection.